Primary care management of alcohol use disorder in rural, remote, and northern settings.

Alcohol consumption is a leading cause of substance-related morbidity and mortality globally. In Canada, there are established Guidelines for Low-Risk Drinking, which are designed to reduce the risk of disease, injury, or death by outlining recommended maximum volumes of, and frequency for, alcohol consumption (Butt, Beirness, Gliksman, Paradis, &Stockwell, 2011). Exceeding the recommended limits places individuals at risk of developing alcohol use disorder (AUD), and subsequently increases the likelihood of alcohol-related adverse health outcomes. In rural, remote, and northern British Columbia (BC), there are significant rates of AUD and alcohol-related morbidity and mortality. In these geographic areas, the responsibility for recognition and treatment of patients with AUD usually resides with the primary care provider. Primary care management of patients with AUD in BC is supported by evidence-based treatment guidelines; however, these guidelines suggest that certain patients may benefit from referral to specialist AUD services, which may be a barrier to treatment in this geographic context. In rural, remote, and northern BC, primary care providers often experience significant barriers to referral of patients outside of the home community, suggesting that the guidelines may be discordant with the realities of AUD treatment in these areas. In order to improve AUD treatment, participation and success within patients’ home communities, an integrative review was conducted to assess the optimum primary care treatment modalities within rural, remote, and northern settings. The findings from this integrative review suggest that there are some modifications to current primary care practice, which could benefit patients with AUD in rural, remote, and northern BC. In order to enhance treatment options for future patients with AUD, recommendations for primary care practice, nurse practitioner education, and further research are proposed.